Norbert-Claude Gorin1,2, Myriam Labopin2, Tomasz Czerw3, Thomas Pabst4, Didier Blaise5, Pierre-Yves Dumas6, Damir Nemet7, William Arcese8, Silvia Maria Trisolini9, Depei Wu10, Anne Huynh11, Tsila Zuckerman12,13, Ellen Meijer14, Seckin Cagirgan15, Jan Cornelissen16, Mohamed Houhou1, Emmanuelle Polge1, Mohamad Mohty1, Arnon Nagler2,17. 1. Department of Hematology and Cellular Therapy, European Society for Blood and Marrow Transplantation (EBMT), National Institute of Health and Medical Research (INSERM) Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France. 2. EBMT Office, INSERM Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France. 3. Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland. 4. Department of Oncology, University Hospital Bern, Bern, Switzerland. 5. Aix Marseille University, CNRS, INSERM, CRCM, Institut Paoli-calmettes, Marseille, France. 6. Department of Hematology, Haut-Leveque Hospital, University Hospital Center of Bordeaux, Pessac, France. 7. Department of Hematology, University Hospital Center Rebro, Zagreb, Croatia. 8. Stem Cell Transplant Unit, Rome Transplant Network, Tor Vergata University Polyclinic, Tor Vergata University, Rome, Italy. 9. Department of Cellular Biotechnology and Hematology, Louisiana Sapienza University, Rome, Italy. 10. Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou Jiangsu, China. 11. The Cancer University Institute of Toulouse Oncopole, Toulouse, France. 12. Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel. 13. Technion-Israel Institute of Technology, Haifa, Israel. 14. Department of Hematology, Free University Medical Center, Amsterdam, the Netherlands. 15. Department of Hematology, Ege University Medical School, Izmir, Turkey. 16. Daniel den Hoed Cancer Center, Erasmus Medical Center, Rotterdam, the Netherlands. 17. Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Abstract
BACKGROUND: Autologous stem cell transplantation (ASCT) for adult acute myelogenous leukemia (AML) is a valid therapeutic option for patients with good-risk and intermediate-risk disease. The authors used the registry of the European Society for Blood and Marrow Transplantation to compare combined busulfan and melphalan (BUMEL) with combined busulfan and cyclophosphamide (BUCY) before transplantation. METHODS: From 2005 to 2013, 853 patients with available cytogenetics underwent ASCT in first remission, including 257 after receiving BUMEL and 596 after receiving BUCY. The proportion of patients with good-risk AML was lower in those who received BUMEL (14% vs 20%; P = .02). More patients who received BUMEL underwent autograft in molecular remission (89% vs 78%; P = .02). Three years after transplantation, the relapse incidence (RI) was 48.7%, the leukemia-free survival (LFS) rate was 47.7%, the overall survival (OS) rate was 66.2%, and the nonrelapse mortality (NRM) rate was 3.6%. RESULTS: Patients who underwent an autograft after receiving BUMEL fared better than those who underwent an autograft after receiving BUCY with a lower RI (39.5% vs 52.2%; hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.49-0.87; P = .003) a better LFS (55.4% vs 44.6%; HR, 0.69; 95% CI, 0.53-0.89; P = .005), and a better OS (73.8% vs 63%; HR, 0.62; 95% CI, 0.47-0.82; P = .0007). There was no difference in the NRM rate (BUMEL vs BUCY, 4.5% vs 3.2%, respectively). Among 74 patients in the BUMEL group and 187 in the BUCY group who underwent autograft in molecular remission, the RI was 30% versus 51%, respectively (univariate analysis; P = .01), and the LFS rate was 66% versus 47%, respectively (univariate analysis; P = .03). CONCLUSIONS: In patients with AML in first complete remission who undergo ASCT, the BUMEL combination is a better preparative regimen. Cancer 2017;123:824-31.
BACKGROUND: Autologous stem cell transplantation (ASCT) for adult acute myelogenous leukemia (AML) is a valid therapeutic option for patients with good-risk and intermediate-risk disease. The authors used the registry of the European Society for Blood and Marrow Transplantation to compare combined busulfan and melphalan (BUMEL) with combined busulfan and cyclophosphamide (BUCY) before transplantation. METHODS: From 2005 to 2013, 853 patients with available cytogenetics underwent ASCT in first remission, including 257 after receiving BUMEL and 596 after receiving BUCY. The proportion of patients with good-risk AML was lower in those who received BUMEL (14% vs 20%; P = .02). More patients who received BUMEL underwent autograft in molecular remission (89% vs 78%; P = .02). Three years after transplantation, the relapse incidence (RI) was 48.7%, the leukemia-free survival (LFS) rate was 47.7%, the overall survival (OS) rate was 66.2%, and the nonrelapse mortality (NRM) rate was 3.6%. RESULTS:Patients who underwent an autograft after receiving BUMEL fared better than those who underwent an autograft after receiving BUCY with a lower RI (39.5% vs 52.2%; hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.49-0.87; P = .003) a better LFS (55.4% vs 44.6%; HR, 0.69; 95% CI, 0.53-0.89; P = .005), and a better OS (73.8% vs 63%; HR, 0.62; 95% CI, 0.47-0.82; P = .0007). There was no difference in the NRM rate (BUMEL vs BUCY, 4.5% vs 3.2%, respectively). Among 74 patients in the BUMEL group and 187 in the BUCY group who underwent autograft in molecular remission, the RI was 30% versus 51%, respectively (univariate analysis; P = .01), and the LFS rate was 66% versus 47%, respectively (univariate analysis; P = .03). CONCLUSIONS: In patients with AML in first complete remission who undergo ASCT, the BUMEL combination is a better preparative regimen. Cancer 2017;123:824-31.